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Digital papillary adenocarcinoma (DPAc) is a rare and aggressive cutaneous malignancy of sweat gland derivation. We conducted a retrospective study of 213 patients with DPAc using the 17 registries of the Surveillance, Epidemiology, and End Results (SEER) Program. We estimated the incidence of DPAc to be 0.11 per million persons per year, with the incidence rising over the past two decades. Our study shows DPAc to most commonly affect White men, typically in their forties to sixties. We noted a 5-year disease-specific survival of 98.3% and 5-year overall survival of 95.7%. We also showed advanced age to be associated with more aggressive disease and identified tumour size as an independent risk factor affecting disease-specific survival. Our results also suggest that patients with DPAc have an elevated risk of developing subsequent primary malignancies, with men being at increased risk of developing lung/bronchial neoplasms and women being at increased risk of developing breast cancer., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Much like the update in the classification of the acne commensal from Propionibacterium acnes (P. acnes) to Cutibacterium acnes (C. acnes) , the treatment of acne has observed advances, augmenting topical and oral medications, including anti-microbial peptides, chemical peels, microencapsulated medications, and probiotics. The traditional paradigm of acne treatment has its limitations, such as skin irritation, photosensitivity, concern over antibiotic resistance, and regimen complexity. Given these challenges, discussing alternative options for acne treatment in detail is important. Light therapy, in particular, is an emerging modality that has transformed the landscape of acne management and thus merits additional discussion (Table 1).

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Biofilm development in gram negative bacterial contaminants in water supply systems is linked to persistence as well as antibiotic resistance, which threatens water quality and hence the public health. This study aimed to investigate phenotypic and genetic capacity of biofilm formation by Escherichia coli isolated from supply water with their antibiotic susceptibility pattern. Altogether fifty water samples collected from a city supply water distribution scheme in Kathmandu were analyzed to assess the physicochemical and microbiological quality. Comparing Nepal's national drinking water quality standards 2022, conductivity (4%), turbidity (18%), iron (28%), and residual chlorine (8%) were found exceeding the values above the standards. Among total, 40% of water samples were contaminated with total coliform bacteria. E. coli and Citrobacter species were dominant and isolated from 20 (64.52%) and 11 (35.48%) water samples, respectively. Antibiotic susceptibility testing revealed that E. coli isolates were resistant to ampicillin (20%), nitrofurantoin (10%), and cefotaxime (10%). Citrobacter spp. (54.54%) were found multidrug resistant (MDR) while none of the isolates of E. coli were MDR. Of total, 45% of the isolates developed biofilm while testing with the Microtiter plate method. Biofilm-forming genes bcsA and csgD in E. coli isolates were detected with polymerase chain reaction (PCR) employing specific primers. bcsA and csgD genes were detected in 55% and 45% of the isolates, respectively. This study confirms the occurrences of biofilm forming and antibiotic resistant bacteria like E. coli in the drinking water supply system in Kathmandu alarming its environmental circulation and possible public health threat. Although further study is warranted, this study suggests public health and drinking water treatment interventions to mitigate the biofilm forming antibiotic resistant potential pathogens from supply water in Kathmandu, Nepal. PRACTITIONER POINTS: Forty percent of tested drinking water samples in Kathmandu were contaminated with total coliform bacteria. E. coli and half of Citrobacter spp. isolates were resistant to multiple antibiotics. bcsA and csgD genes were detected in biofilm producing E.coli isolates., (© 2024 Water Environment Federation.)

Wastewaters serve as significant reservoirs of antibiotic resistant bacteria. Despite the evidence of antimicrobial resistance in wastewaters and river water in Kathmandu, direct linkage between them is not discussed yet. This study investigated the prevalence of extended-spectrum β-lactamase (ESBL)-producing bacteria and associated resistance genes in wastewaters and river water. Out of 246 bacteria from wastewaters, 57.72% were ESBL producers and 77.64% of them were multidrug resistant (MDR). ESBL producing E. coli was dominant in municipal and hospital wastewaters (HWW) as well as in river water while K. pneumoniae was common in pharmaceutical wastewater. The bla SHV and bla TEM genes were prevalent and commonly co-occurred with aac(6')-Ib-cr in K. pneumoniae isolated pharmaceutical wastewater. bla CTX-M carrying E. coli from hospital co-harbored aac(6')-Ib-cr while that from municipal influent and river water co-harbored qnrS. Whole genome sequencing data revealed the presence of diverse ARGs in bacterial isolates against multiple antibiotics. In average, an E. coli and a K. pneumoniae isolate contained 55.75 ± 0.96 and 40.2 ± 5.36 ARGs, respectively. Multi-locus sequence typing showed the presence of globally high-risk clones with wider host range such as E. coli ST10, and K. pneumoniae ST15 and ST307 in HWW and river indicating frequent dissemination of antimicrobial resistance in wastewater of Kathmandu. Whole genome sequence data aligned with phenotypic antibiograms and resistance genes detected by PCR in selected isolates. The presence of significant plasmid replicons (IncF, IncY) and mobile genetic elements (IS903, IS26) indicate high frequency of spreading antibiotic resistance. These findings indicate burden and dissemination of antimicrobial resistance in the environment and highlight the need for effective strategies to mitigate the antibiotic resistance., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Although lidocaine is widely used in dermatologic surgery, no formal standard concentration is established. Previous research indicates that more dilute concentrations may offer equally effective anesthesia while potentially reducing toxicity risks. In addition, diluting commercially available lidocaine conserves supplies-a significant benefit during periods of lidocaine shortage., Objective: To evaluate the efficacy of 0.25% lidocaine compared with that of 0.5% lidocaine in achieving anesthesia in cutaneous surgery., Materials and Methods: A prospective, double-blind study with 100 patients undergoing cutaneous surgery (Mohs surgery or excision) randomized to receive either 0.25% or 0.5% lidocaine for their percutaneous anesthesia. Patients completed a postoperative survey assessing pain level, satisfaction, and willingness to undergo future dermatologic surgery., Results: This study revealed no statistically significant differences between the 0.25% and 0.5% lidocaine groups regarding pain scores, patient satisfaction, total lidocaine volume, rescue lidocaine volume, or willingness to undergo the procedure again., Conclusion: 0.25% lidocaine is a safe and effective option for achieving anesthesia during Mohs surgery and standard excisions. The results suggest that 0.25% lidocaine can be used to optimize high-value care and enhance patient safety in dermatologic surgery., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Pityriasis rubra pilaris (PRP) is a rare papulosquamous reaction pattern with a significant impact on quality of life. Type I PRP is the most common PRP variant, presenting as erythematous papules emerging in a follicular distribution and later coalescing into plaques with characteristic islands of sparing; histologically, an alternating pattern of orthokeratosis and parakeratosis is considered the hallmark of PRP (checkerboard hyperkeratosis). Other PRP variants (types II-V) differ in their age of onset and clinical presentation. Type VI PRP is a rare PRP subtype associated with human immunodeficiency virus infection and is occasionally associated with diseases of the follicular occlusion tetrad. Caspase recruitment domain family, member 14 (CARD14)-associated papulosquamous eruption and facial discoid dermatitis are newly described disease states that have an important clinical overlap with PRP, creating shared conundrums with respect to diagnosis and treatment. The etiology inciting PRP often remains uncertain; PRP has been suggested to be associated with infection, malignancy, or drug/vaccine administration in some cases, although these are based on case reports and causality has not been established. Type V PRP is often due to inborn CARD14 mutations. Furthermore, recent literature has identified interleukin-23/T-helper-17 cell axis dysregulation to be a major mediator of PRP pathogenesis, paving the way for mechanism-directed therapy. At present, high-dose isotretinoin, ixekizumab, and secukinumab are systemic agents supported by single-arm prospective studies; numerous other agents have also been trialed for PRP, with variable success rates. Here, we discuss updates on clinical manifestations, present new insights into etiopathogenesis, and offer a survey of recently described therapeutic options., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction Merkel cell carcinoma is an aggressive neuroendocrine tumor that is related to immunosuppression and the Merkel cell polyomavirus. It is more common on the head and neck and has been associated with other skin malignancies such as basal cell carcinoma, squamous cell carcinoma, and melanoma. However, there has never been a nationwide investigation that quantifies Merkel cell carcinoma's connection with these subgroups. Methods Utilizing the National Institutes of Health's All of Us open-access database, a retrospective study was conducted by filtering for Merkel cell carcinoma through the International Classification of Diseases, 9th and 10th Clinical Modification codes 209.* and C4A.*, respectively. This led to the inclusion of 41 patients in the study, with each instance compared to four control patients without merkel cell carcinoma, matched by age, race, and gender. The data's demographics and skin cancer co-morbidities were collected and evaluated with odds ratios and 95% confidence intervals using Wald's method. Results In patients with merkel cell carcinoma, a statistically significant gradient of increasing risk for developing basal cell carcinoma (Odds Ratio, 11.63; 95% Confidence Interval, 4.30-31.45; P < 0.0001), squamous cell carcinoma (Odds Ratio, 15.09; 95% Confidence Interval, 3.87-58.84; P = 0.0001), and melanoma (Odds Ratio, 27.94; 95% Confidence Interval, 3.26-239.48; P = 0.0024) was observed. The race/ethnicity demographics showed that 85.4% of the patients were white, and they were at the highest risk of developing merkel cell carcinoma. However, the study has limitations, such as the inability to identify the stage of merkel cell carcinoma among patients and the lack of consideration for other confounding variables. Conclusion The study examines the link between merkel cell carcinoma and other skin malignancies, underscoring the need for more national research to better understand the underlying causes that contribute to this link. The findings also indicate the possibility of sample bias in the All of Us database, emphasizing the need to assess the patient population's representativeness in such investigations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Verma et al.)

The emergence of carbapenem resistant bacteria (CRB) possesses a remarkable threat to the health of humans. CRB and carbapenem resistance genes (CRGs) have frequently been reported in clinical isolates from hospitals, however, their occurrence and distribution in wastewaters from various sources and river water have not been emphasized in Nepal. So, this study aimed to detect carbapenem resistant bacterial isolates and their resistance determinants in river water and different types of wastewaters. River water and both untreated and treated wastewater samples from hospitals, pharmaceutical industries, and municipal sewage were collected in summer and winter seasons. From 68 grab wastewater samples, CRB were detected only in 16 samples, which included eight hospital wastewater, and four each from untreated municipal sewage and river water. A total of 25 CRB isolates were detected with dominance of E. coli (44.0%) and K. pneumoniae (24.0%). The majority of the isolates harbored bla NDM-1 (76.0%), followed by bla OXA (36.0%) and bla KPC (20.0%) genes. Hospital wastewater majorly contributed to the presence of bla NDM-1 , bla KPC , and bla OXA along with intI1 genes compared to river water and untreated municipal sewage, especially during the winter season. However, CRB were not detected in treated effluents of hospitals and municipal sewage, and both influents and effluents from pharmaceutical industries. The combined presence of each bla NDM-1 & bla OXA and bla KPC & bla OXA occurred in 16.0% of the bacterial isolates. The increased minimum inhibitory concentration (MIC) of meropenem was significantly associated with the presence of CRGs. The results of this study highlight the significance of carbapenem resistance in bacteria isolated from wastewater and river water, and underscore the necessity for efficient monitoring and control strategies to prevent the dispersion of carbapenem resistance in the environment and its potential consequences on human health., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Competing Interests: Conflicts of interest the authors declare no conflicts of interest. G.N.D, S.J., R.S., R.T., A.X.W. and S.Z. contributed equally.

Neutrophilic dermatosis of the dorsal hands (NDDH) is a variant of Sweet syndrome that presents with erythematous bullae, papules/plaques, or pustules on the dorsal hands. It is most commonly associated with hematologic and solid organ malignancies, though cases of NDDH associated with inflammatory bowel disease, rheumatologic disorders, and medication exposure have also been described in the literature. Felty syndrome is a rare complication of long-standing rheumatoid arthritis characterized by neuropathy, splenomegaly, and neutropenia. Granulocyte colony stimulating factors (e.g., filgrastim) can be utilized to rescue the neutropenia observed in Felty syndrome, but this treatment may subsequently cause Sweet syndrome. Herein, we present a 64-year-old man with Felty syndrome and a complex medical history who presented with sudden onset, painful blisters located on the dorsal and palmar aspects of his bilateral hands. Given the patient's past medical history, a broad differential diagnosis, including disseminated fungal and viral infection was initially considered. A punch biopsy of the skin lesion disclosed neutrophilic dermatosis, which together with laboratory data satisfied the von den Driesch criteria for Sweet syndrome. As the lesions were localized exclusively on the patient's hands, the qualification of NDDH was also endorsed.

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Competing Interests: Conflicts of interest the authors declare they have no conflicts of interest.

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According to a recent survey, Nepal's urban air quality has been classified as one of the worst in the globe. A large portion of the country's population is subjected to health risks caused by air pollution. As Nepal has a wide variation in altitude coupled with socio-cultural and biological diversities, it is important to understand the different health hazards in the different geographical regions - Terai, Hills and Mountains. Constantly increasing physical infrastructures (such as transport vehicles, open burning of plastics and other fuels) are the main reasons for the escalating air pollution in the country. This study aims to critically review the current air pollution status in different geographical locations along with its impacts on public health in the country. It has been revealed that irrespective of geographic location, the air pollutants interfere with different human physiological systems related to respiration as well as cardiovascular, ophthalmic, and gastrointestinal functioning. Further, the research findings highlighting the influence of prolonged exposure of the population to the air pollution leading to the significant number of deaths have been presented. A notable rise in the number of hospitalized patients suffering from illnesses related to above mentioned pollution borne cases has been reported., Competing Interests: Declaration of competing interest The authors declare that there are no relevant financial or non-financial competing interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Competing Interests: Conflicts of interest None disclosed.

Microplastic pollution in a freshwater environment has captured the attention of the scientific world in recent years. Microplastic is a new area of research in the freshwater of Nepal. Hence, the present study aims to examine the concentration, distribution, and characteristics of microplastic pollution in the sediments of Phewa Lake. Twenty sediment samples were collected from 10 sites to cover the vast area (5.762 km 2 ) of the lake. The mean abundance of microplastic was 100.5 ± 58.6 items/kg dry weight. The average abundance of microplastics in five sections of the lake showed a significant difference (test statistics = 10.379, p < 0.05). Fibers (78.11%) dominated the sediments of Phewa Lake in all sampling sites. Transparent was the prominent color observed followed by red and altogether 70.65% of the microplastics detected were found at 0.2-1 mm size class. Fourier transform infrared spectroscopy (FTIR) analysis of visible microplastic particles (1-5 mm) confirmed polypropylene (PP) (42.86%) as the dominant polymer type followed by polyethylene (PE). This study can help to bridge the knowledge gap regarding the microplastic pollution in freshwater shoreline sediments of Nepal. Furthermore, these findings would create a new research area to explore the impact of plastic pollution which has been ignored in Phewa Lake., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Competing Interests: Conflicts of interest the authors declare they have no conflicts of interest.